Hospital Status Reporting Guidelines

1
Hospital Status Reporting Guidelines

• September 2005

2
WHY THE CHANGE?

• Concerns for Patient Care
• Communications between ED and Squad personnel
• Overcrowded Hospitals prompt diversions
  burdening EMS systems, leads to prolonged
  transports and delays in care.
• Hospitals compete for diversion status to
  decompress overcrowded ED
• On Diversion or At Capacity does not convey to
  EMS each hospitals actual ED capability to
  receive patients

3
New Guidelines Address Concerns

• Communications between ED and EMS
• Conflict resolution process
• EMS will continue to transport certain patients
  to overcrowded ED
• Training for EMS/ED staff, jointly designed by
  EMS Caucus and Health Council to address
  concerns/reduce conflicts

4
New Guidelines Address Concerns

• Overcrowded Hospitals want EMS to Fix problem by
  expecting EMS to divert all patients.
• Responsibility / focus in new Guidelines switched
  from EMS to hospitals
• Title changed to Hospital Status Reporting to
  replace Ambulance Diversion
• Hosp. notifies EMS of status / requesting EMS
  inform pt. of overcrowded situation
• EMS will explain hospitals status to the patient
• Hospital destination is patients choice

5
New Guidelines Address Concerns

• Hospitals compete for diversion status to
  decompress overcrowded ED
• No geographic limits on number of hospitals that
  report themselves as being At or Over Capacity
• New Terms At Capacity and Over Capacity
  have distinct definitions / convey important
  differences
• Second and subsequent hospitals in geographic
  area must discuss their capability with partner
  hosp. prior to reporting At or Over Capacity

6
New Guidelines Address Concerns

• Old On Diversion or At Capacity does not
  convey actual difference in ED capability to
  receive patients
• Now, At Capacity means that the hospitals ED
  and supporting resources are fully committed
• Now, Over Capacity means that the hospitals ED
  and supporting resources are over committed

7
What have the Hospitals done over past three
years to improve capacity?

• Expanded number of ED beds by 58
• Increased number of ICU/CCU, Telemetry, and
  Step-Down beds by 220
• Created position of Bed Placement Specialist,
  expediting the flow of patients from ED through
  internal transfer and discharge
• Decreased staff vacancy rates by average of 21
  in EDs by 29 on in-patient units
• Created new staff person, HOSPITALIST, to
  improve care expedite timing of
  transfers/discharges
• From CGHC Survey of only those hospitals (13)
  that communicate status via website

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Hospital plans to improve capacity over next
three years

• Increasing ED beds by 37
• Increasing ICU/CCU, Telemetry, and Step-Down
• beds by 148
• Increasing medical/surgical beds by 86
• Increasing total number of inpatient beds
• Loaning nursing staff with graduate degrees to
  schools of nursing to enable the schools to
  increase their number of graduates
• From CGHC Survey of only those hospitals (13)
  that communicate status via website

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Specific Provisions of New Guidelines

• Status Definitions
• Normal the hospitals emergency department and
  its supporting resources are operating normally
• At Capacity the hospital has determined that
  its emergency department and the emergency
  departments supporting resources are fully
  committed
• Over Capacity the hospital has determined that
  its emergency department and the emergency
  departments supporting resources are
  over-committed
• Closed the hospital has activated its disaster
  plan because of an internal emergency, bomb
  threat, or other situation rendering it unable to
  accept patients

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Specific Provisions of New Guidelines(cont.)

• Situations when EMS must transport to At or Over
  Capacity Hospital
• Patient is unstable
• Airway, CPR, uncontrolled hemorrhaging, etc.
• Hospital has specific services the pt needs
• OB, major burns, hyperbaric oxygen, etc.
• ALS level pt. - bypassing hospital on At or Over
  Capacity would mean a transport time greater than
  15 additional minutes
• EMS personnel have advised the patient of At or
  Over Capacity situation and patient still wishes
  to be transported to their initial choice

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Specific Provisions of New Guidelines (cont.)

• EMS will notify patients about hospital-At or
  Over Capacity Status
• Explanation of the meaning of either At
  Capacity or Over-Capacity
• Patients may experience longer waits when going
  to a hospital reporting one of these two statuses
• Questions EMS should be prepared to answer
• What happens with your physician when you go to
  another ED
• General questions about insurance coverage for
  emergency care at out-of-network hospitals
• The remote possibility, for insurance purposes,
  of patients having to be transferred to an
  in-network hospital

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Specific Provisions of New Guidelines (cont.)

• Conflict Resolution between ED and EMS
• Disengage immediately
• Personnel should report the incident and names of
  those involved to their supervisor as soon as
  possible (Pt. care must not be jeopardized)
• Supervisor should then contact, as appropriate,
  either the ED nurse manager of the facility or
  the EMS supervisor of the fire dept./EMS agency
  and discuss the incident with him/her

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Specific Provisions of New Guidelines (cont.)

• To provide more accurate status information to
  EMS, each hosp. in geographic area must report
  who has somewhat better ability to receive and
  care for EMS patients
• Second and subsequent hospitals wanting to report
  themselves At or Over Capacity must first call
  their partner hospitals to discuss their
  situation with them
• There is no limit on the number of hospitals that
  can report themselves At or Over Capacity

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Benefits / Outcomes of Changes

• EMS receives more specific, more accurate
  information to help patients make choices of
  hospital destination
• ED personnel now expect that squads will bring
  patients to hospital when At or Over Capacity
• EMS and ED staff have specific steps to follow if
  conflicts take place

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Benefits / Outcomes of Changes

• Hospital Status Task Force has/will
• Has verified that Insurance Co. Policies
  regarding paying for non-network hosp. are still
  in effect
• Will improve notification of private ambulance
  squads about hospitals being At or Over
  Capacity
• Will develop process for notification of nursing
  homes about hospitals being At or Over Capacity
  status
• Will develop plan for improving physicians
  understanding of the impact they can have on a
  hospitals ability to admit and care for the
  patient

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Continuous Improvement

• as always, any operational or policy issues /
  problems can be brought to the Hospital Status
  Task Force for discussion and resolution
• Contacts
• Trish Brooks 513-595-5243
• Colleen OToole 513-531-0200